HomeMy WebLinkAboutBLD2009-00294 GILDING PERMIT APPLICATOR) BLD09-00294
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD09-00294 Received Date: 9/2/2009
SITE ADDRESS: 63 RIDGE DR
PORT TOWNSEND, 98368
OWNER: ROBERT B BEAZLEY PHONE: 206-529-4391
TERRI L ZIMMERMAN
11705 29TH AVE SE
EVERETT WA 982086025 CAPE GEORGE VILLAGE DIV 4
SUBDIVISION: Block: Lot: 1
PARCEL NUMBER: 940800001 Section: 13 Township: 30 N Range: 02 W
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOI' NEW DECK
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP DEK MAIN:
VALUATION 12,874.00 gDD'L: HEAT TYPE:
CODE EDITION: 2006 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: # OF STORIES:
OCCUPANCY: OTHER:
CONST TYPE: GARAGE: SHORELINE:
CONST TYPE: DECK: 480 SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL:
WATER SYSTEM:
BEDROOMS: BATHROOMS:
Exist: 0 Exist: 0
Prop: 0 Prop: 0
Total: 0 Total: 0
Routing Date:
`1'J
Type Amount Paid Bv: Date: Receipt: Approved/Date
Permit $223.25 LYK 09/02/09 110867 APIDR )VEI
Plan Check $145.11 LYK 09/02/09 110867
State Building Code $4.50 LYK 09/02/09 110867
Total: $372.86 SEP it) 2009
Jefferson County Planning
& Building Department
Jefferson County Building Dion Permit Numb* BLD09-00294
Applicant: BEAZLEY
BUILDING PERMIT INSPECTION APPROVALS \pplicable Code: 2006 International Building Codes
To schedule inspections, call (360)379-4455 no later than 7:00 AM the day of the inspection.
Requests received after 7:00 AM will not be scheduled for that day's inspections.
ELECTRICAL PERMITS are issued by the Washington State Department of Labor& Industries.
The electrical permit must be signed off by the State Inspector prior to the County's Framing Inspection
Inspection Item Date Approval Signature Notes
Setbacks
Foundation Footing
FINAL INSPECTION 44q
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
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DEPARTMENT OF COMMUNITY DEVELOPMENT
�' ` `4 621 Sheridan Street • Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax
4q`SFi7NCsSO� www.co.jefferson.wa.us/commdevelopment
Master Permit Application MLA: j MYNA 't
Project Description(include separate sheets as necessary):
Tax Parcel Number: f J1C 2 2 c)o 9 Property Size:
(acres/square feet)
Site Address and//for Directions to Property: 0
Property Owner(s)of ecord: -f� -' 9 1>$ 7j1 . f
Telephone: Fax: """� email:
Mailing Address: f/ 70 I ve &,,,,.a S- �G L` Vj cP a. o
Applicant/Agent(if different from owner):
Telephone: 3 6 d j 7 9—5--7 L 6 Fax: email:
Mailing Address:
What kind of Permit?(Check each box that applies ❑Lot or Road Segregation
Building J1L 0 Critical Areas Stewardship Plan
❑ Demolition Permit 0 Variance(Minor, Major or Reasonable Economic Use)
❑ Single Family ❑ Garage Attached/Detached ❑Conditional Use[C(a), C(d),or C]**
❑ Manufactured Home . 0 Modular 0 Discretionary"D"or Unnamed Use Classification
❑ Commercial* ❑Special Use(Essential Public Facilities)**
❑ Change of Use 0 Boundary Line Adjustment
❑ Address 0 Road Approach 0 Short Plat**
❑ Home Business 0 Cottage Industry ❑Binding Site Plan**
❑ Propane 0 Long Plat**
❑ Slyn 0 Planned Rural Residential Development(PRRD)/Amendments** '
❑Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration**
❑Stormwater Management 0 Shoreline Master Program Exemption/Permit Revisions**
❑Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Substantial Development**
❑Temporary Use 0 Shoreline Management Variance
❑Wireless Telecommunication* 0 Comprehensive Plan/UDC/Land Use District Map Amendment
❑ Forest Practices Act/Release of Six-Year Moratorium ❑Jefferson County Shoreline Master Program Amendment
*May require a Pre—Application Conference ❑Tree Vegetation Request
**Requires a Pre-Application Conference
Please identify any other local,state or federal permits required for this proposal, if known:
DESIGNATION OF AGENT
I hereby designate to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE Date:
By signing this application form,the owner/agent attests that the information provided herein,and in any attachments,is true and correct to the best of
les her or its knowledge. Any material falsehood or any omission of a material fact made by the owner/agent with respect to this application packet
nay result in this permit being null and void.
further agree to save,indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable attorney's fees and
expenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit.
further agree to provide access and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application
eview and any required later inspections. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the
ime of the agp3cation that he or she wants prior notice.
signature:'_ --c-.`F . Gf 2 L Date: g— 4Z O
'he action or actions Applicant will undertake as a result of the issuance of this permit may negatively impact upon one or more threatened or
ndangered species and could lead to a potential"take"of an endangered species as those terms are defined in the tederal law known as the
Endangered Species Act"or"ESA."Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this
ermit has been issued will not violate the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your
::tion(s)even if you are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual
id non-transfrabl .responsibil; or adh ing to and co plying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
ignature: Ivp-- i(c3 `
Date: 9'— �. — o I,'
PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc
• •
BUILDER STATEMENT
The signer of this statement does hereby certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that
they will be assuming the responsibility of the General Contractor for the proposed project.
-t Date: 7- 2 — O f
e.-Signature: '- r ''
FAX:GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALL R: PHONE: ( )
( )
MAILING ADDRESS: EMAIL:
CONTRACTOR'S LICENSE WAINS
NUMBER: NUMBER . .
ARCHITECT/ENGINEER: PHONE ( ) FAX:( )
MAILING ADDRESS: EMAIL
Project Type: Type:T e: Bathrooms: Shoreline: Type of Sewage Disposal:
❑ Sewer
0 New Wood Existing: Bank ❑ Community System Proposed:
❑ Addition ❑ Steel Height:❑ Alteration/Remodel ❑ Concrete Total: _ Hei 9 ❑ Individual System
❑ MasonrySEP Permit#
❑ De Bedrooms: Water Supply:
• Demolition ❑ Other: Existing: Setback: ❑ Private well ❑ Two Party
Proposed: ❑ Public
Type of Heat: Total: Name of System: •
If this is a Commercial Project you must answer the following:
Number of Parking Spaces: Current: Proposed: Number of ADA Parking Spaces:
Number of occupants(includes owners,tenants,employees,etc) Current Proposed
Type Occupancy:
IBC T e of construction: Will you have Food Service? Yes / No
If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply:
i Underground Tank 1 Above ground Tank Size of Propane Tank:
1 Heat Stove 1 Cook Stove 1 Woodstove i Fireplace Insert 1 Hot Water Tank 1 Pellet Stove i Other
Is this appliance being installed in a Manufactured/Mobile Home? Yes / No
When applying for a permit to install a propane tank you must also submit a site plan showing all of the buildings,all property
lines, tank location and size,distances from the propane tank to all property lines,buildings and septic system components,
including the reserve area.
Square Footage , Current Proposed For Office Use Only Amount Revision
EH Bld A Review:
Main Floor Heated pp
2`d Floor Heated Consistency Review: ____---
Other Heated Base fee: /j �5
Mezzanine Additional Section: O(
Heated Basement Plan Check fee: l 45 I
Unheated Basement State Surcharge fee: Sl
Other Unheated Pot Water Review fee:
Garage/Carport SUBTOTAL
.13
Decks I , ( v 9 1/Rd Approach fee:
`f
Other TOTAL: $312 _gic.
Receipt Number: 1 l uSG-1
Cash/Check Number: l t If', i 13
ESTIMATED COST(REQUIRED) Date: �-^31)9
.Fair market value of all labor and materials foundation to finish Initials:
G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc